Voting

COPD exacerbations contribute to poor quality of life, lung function and functional decline. In addition, they are costly to the patient and to health care cost. However, they remain defined exclusively on symptoms and constitute a “soft” endpoint. Actually, the number of exacerbations has become the GOLD standard to establish the risk of outcome (exacerbations). However, a mild episode that only requires outpatient
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Analysis: To evaluate the level of accuracy of the re-classification of the episode and to relate the level of biomarker change to the severity of the episode.

Feasibility and challenges of addressing this CQ or CC:

Study Plan

A change in paradigm can be explored using an approach similar to that developed in the field of cardiovascular disease for coronary artery disease. This can be seen in the table from the article (Celli B and Barnes P J. Exacerbations of COPD. 2007;29:1224), which shows the basis for the proposal where we would add the biomarkers described above.

Name of idea submitter and other team members who worked on this idea:
American Thoracic Society member

Voting

What measures other than PFT data can be used to predict risk of 1) COPD exacerbations (e.g., hospitalization, urgent care visit, or ED visit for COPD exacerbation) or 2) relapse (e.g., re-hospitalization, urgent care visit, or ED visit) following hospital discharge after treatment of COPD exacerbations?

COPD is underdiagnosed. The lack of recognition of COPD risk by physicians and patients themselves is well known, with many undiagnosed COPD patients presenting for the first time with late stage COPD. Currently used cut-points based on a fixed ratio of FEV1/FVC may overestimate the number of elderly patients with COPD, particularly with mild disease, because of changes in lung volumes with aging. It has been suggested that using a cut-point based on the normal distribution of FEV1/FVC values may decrease the misclassification rate. Other strategies have been proposed for risk assessment as adjuncts to diagnostic classification (e.g., Fragoso et al. J Am Geriatr Soc 2008, 56:1014-1020). Pertinent references: Guideline #1 in Qaseem et al., strong recommendation, moderate-quality evidence; GOLD, 2008 and the 2005 American Thoracic Society/European Respiratory Society Task Force Report, standards for the diagnosis and management of patients with COPD.

Although there are ample guidance to help providers identify and evaluate patients likely to have earlier stage COPD, few are referred to spirometric testing. Subsequent spirometry provides a good working yield of true positives, which is frequently superior to pre-test probabilities of other, more complex and expensive medical tests commonly ordered for other conditions (colonoscopy,lung cancer), why is it so much more difficult to provide spirometry? COPD will remain undertreated as long as it remains underdiagnosed.

Name of idea submitter and other team members who worked on this idea:
Helene Gussin, PhD

Respiratory inhalers come in a staggering array of types, contents, and methods of use. It is not uncommon for the COPD patient to use two or more types of inhalers each day. The misuse of the application of these devices is rampant, due to confusion, forgetfulness, or lack of proper education in their use. If multiple inhalers are used by the patient, many of them must be used in a particular order, and the inhalation methods may will be vastly different.

Understanding on the part of the patient and/or caregiver begins with the initial instruction in the use of inhalers by medical personnel. They must find, and use, methods of instruction that are understandable and retainable by the patient.

Feasibility and challenges of addressing this CQ or CC:

The study of comparing the two type of instruction is entirely feasible, while the challenges lie with studying a large enough sample of patients to encompass the ranges of COPD stages, mental capacity, and degree of compliance of the patients.

Name of idea submitter and other team members who worked on this idea:
Jim Nelson - Patient, Arizona State Advocacy Captain

Voting

What is the impact of an organized, comprehensive, COPD patient education program, on medication delivery effectiveness, care plan adherence, appropriate use of LTOT and Pulmonary Rehabilitation? Metrics could include incidence and severity of exacerbations, and health care resource consumption.

To extend our knowledge of the pathobiology of heart, lung, blood, and sleep disorders and enable clinical investigations that advance the prediction, prevention, preemption, treatment, and cures of human disease.